NPIMap

Organization Active NPI

My Mobile Primary Health Care, LLC

  • Family Nurse Practitioner
  • Silver Spring, MD
National Provider Identifier
1487063640
Registry record updated Jun 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R185090 Issued in MD
Legal business name
MY MOBILE PRIMARY HEALTH CARE, LLC
Practice address
11006 Veirs Mill Rd
Suite L-15-299
Silver Spring, MD 20902-2582
Phone
(202) 681-9661
NPI assigned
Aug 12, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stacey Santiago
Title
Operations Manager
Phone
(256) 508-9034

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X R185090 MD Primary

Addresses

Primary practice location

11006 Veirs Mill Rd
Suite L-15-299
Silver Spring, MD 20902-2582

Mailing address

11006 Veirs Mill Rd
Suite L-15-299
Silver Spring, MD 20902-2582
Phone (202) 681-9661

Other names 1

  • MMPHC Other name

National Provider Directory

National Provider Directory
Tax ID family
Logistics Health Incorporated2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11006 Veirs Mill Rd
Ste L15299
Silver Spring, MD 20902

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434672000000",
    "number": "1487063640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11006 VEIRS MILL RD",
            "address_2": "SUITE L-15-299",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209022582",
            "telephone_number": "202-681-9661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11006 VEIRS MILL RD",
            "address_2": "SUITE L-15-299",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209022582",
            "telephone_number": "202-681-9661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY MOBILE PRIMARY HEALTH CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-12",
        "last_updated": "2015-06-19",
        "status": "A",
        "authorized_official_last_name": "SANTIAGO",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "256-508-9034"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R185090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MMPHC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Silver Spring, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.